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End-of-Life Planning and VA Hospice Program

13 mins read
Larry Dandridge

By Larry Dandridge

The June 3rd article covered the eligibility criteria and the definition of hospice. Last week’s article explained the four levels of hospice care, pain emergency, some of the palliative treatments, and the importance of hospice volunteers. This week’s column will provide a summary of the Veterans Health Administration (VHA) hospice program.

The five-star rated Ralph H. Johnson VA Medical Center (RHJVAMC) in Charleston, SC provides many types of world-class Geriatric and Extended Care services to Veterans. VA hospice care is one of those types of care. VA hospice care is available to all Veterans who are eligible and enrolled in VA health care, regardless of their disability rating. Hospice is one of the benefits of the Veteran Health Administration’s Basic Medical Benefits Package. 

According to page 4 of the Hospice Veteran Partnership Tool Kit, all Medicare-eligible Veterans, whether or not they are enrolled in VHA, have access to hospice care through Medicare. Veterans not eligible for Medicare may have hospice benefits through Medicaid or other private insurance. Unfortunately, like 90% of all Americans, most Veterans simply don’t know that these options exist.

According to the VA web site at www.va.gov/GERIATRICS/pages/Hospice_Care.asp, VA hospice care is comfort care provided to you and your family, if you have a terminal condition, with less than six months to live, if the disease takes its normal course, and you are no longer seeking treatment other than palliative (pain and discomfort control) care. The VA’s multi-disciplinary team approach to hospice care helps Veterans live fully until they die. The VA works closely with community and home hospice agencies to provide care in the veteran’s home. All Veterans enrolled in VA health care are eligible for hospice care, if they meet the clinical eligibility criteria for hospice.

There are no copays for VA hospice care, whether it is provided by the VA or one its contract organizations. Veterans can choose to have insurance, Medicare, Medicaid, or private insurance pay for VA hospice care or have the VA pay for the care. The VA will pay for Nursing Home Care for Veteran hospice patients if the patient is eligible for hospice care and nursing home level of care. Hospice care can be provided wherever the Veteran lives including the home of the Veteran or caregiver, assisted living and long-term care facilities, community nursing homes, community hospitals, VA community living centers, and VA medical centers.

Under VA hospice care, there is no consideration of any kind (cost for example) that limits the amount of palliative care an enrolled Veteran hospice patient can safely receive. Even though the Veteran agrees to end curative treatment for the terminal diagnosis, VA hospice patients can receive palliative surgery, chemo therapy, radiation therapy, blood transfusion, fluid withdrawal, and other such treatments to improve quality of life and function, or to control pain concurrently with hospice. Veterans can also continue to receive dialysis, if the terminal diagnosis is not end-stage renal disease, or to treat health conditions that are not part of the patient’s terminal disease. 

The goal of VA hospice care is to allow the patient to live his or her remaining life as free of pain and discomfort as possible, in the patient’s home or in an inpatient facility like a Skilled Nursing Facility or a VA Inpatient Facility. The RHJVAMC’s inpatient hospice unit is called Liberty Hall, which is located next to the Patriots Harbor Community Living Center (skilled nursing unit) in the VA Medical Center in Charleston. 

The VA’s Liberty Hall Hospice facility and Patriots Harbor are located in the RHJVAMC at 109 Bee Street, Charleston, SC 29401. Liberty Hall and Patriots Harbor have a Patriots Harbor family break room, library, large deck, juke box, activities room, media room, computers, card tables, and other comfort and recreational areas and equipment. Patriots Harbor also has a separate bereavement room for families. Most inpatient hospice patients are in advanced stages of their illness, but if the veteran is well enough, Patriots Harbor may provide opportunities for bowling, fishing, horseback riding, escorted trips to Walmart, and other similar activities for inpatients after the COVID-19 pandemic has ended. Liberty Hall can accommodate seven hospice patients. 

Normally RHJVAMC hospice program provides background checked, trained, motivated, kind, compassionate, and empathetic volunteers to help care for patients, but because of the Coronavirus pandemic and to ensure the safety of patients, families, staff, and volunteers, volunteers are not currently allowed in Liberty Hall. The VA expects to allow volunteers back into Patriots Hall when the COVID-19 pandemic has ended and the risk of infection is deemed low. Liberty Hall and Patriots Harbor have resumed allowing families back into Patriots Hall.

Patriots Harbor is going through an extensive renovation, which will be completed in about ten weeks. There are seven hospice patient rooms in Liberty Hall and there are currently five hospice patients living there. The RHJVAMC has never run out of space for hospice inpatients because the vast majority of patient’s want to live and die at home. The average number of inpatient and outpatient veterans enrolled in the RHJVAMC hospice program is 75-to-100. 

Veterans desiring care at home or in a skilled nursing facility are referred to VA community hospice agency partners (private for-profit and not-for-profit hospices). The RHJVAMC contracts with community hospices to provide hospice care to eligible Veterans. The VA also provides community hospices with veterans in hospice tool kits. You can download a copy of the Hospice Veteran Partnership Tool Kit at https://networkofcare.org/library/veterans-toolkit.pdf. 

The VA is partnered with the National Hospice and Palliative Care Organization (NHPCO) through the “We honor veterans’ program” and The Carolinas Center (TCC) for Hospice Care and local hospices to improve the quality of hospice care for veterans. 

If you or your business are interested in becoming part of the National Hospice Veterans (HVP) program, begin by finding out if an HVP already exists in your state or region. If an HVP has not yet been formed, you can use the Hospice Veteran Partnership Tool Kit toolkit to help get one started. Get more information by contacting one of the following organizations: 

Department of Veterans Affairs Veterans Health Administration 810 Vermont Ave, NW Washington, DC 20420, Christine Cody, National Program Manager, Hospice and Palliative Care, E-mail: Christine.Cody@va.gov Phone: 202/273-8537 

National Hospice and Palliative Care Organization, 1700 Diagonal Road, Suite 625 Alexandria, VA 22314, Phone: 703/837-1500, Fax: 703/837-1233, Donna Bales, Director State Relations E-mail: dbales@nhpco.org Phone: 800/338-8619. 

There is not space in one article to cover all the good things about the Ralph H. Johnson VA Medical Center and the VA Hospice Program. However, it is obvious that Veterans should: 

Contact the RHJVAMC Eligibility/Enrollment Office, room B189, 109 Bee Street, Charleston, phone 843-789-7008 and find out if you are eligible for VA health care and enroll. When you go to the Eligibility Office, take a copy of your DD214 and a picture form of identification (SC driver’s license, etc.). You will need to fill out a VA Enrolment Application for Health Benefits Form 10-10EZ. You can also determine your eligibility for VA health care and enroll in VA health care at one of the RHJVAMC Community Based Outpatient Clinics (CBOCs), which are located in Beaufort, Savannah and Hinesville GA, North Charleston, Charleston Naval Weapons Station, and Myrtle Beach. 

Talk to your VA Social Worker and learn more about end-of-life planning and hospice. 

Read more at these helpful links: 

Ralph H. Johnson, Charleston VA Medical Center Hospice Care – https://www.charleston.va.gov/services/Hospice_Services_for_Veterans.asp and Geriatrics and Extended Care (including hospice) phone: 843-789-7426

Hospice Care – https://www.va.gov/GERIATRICS/pages/Hospice_Care.asp

Palliative Care – https://www.va.gov/GERIATRICS/pages/Palliative_Care.asp

Skilled Home Health Care – https://www.va.gov/GERIATRICS/pages/Skilled_Home_Health_Care.asp

Remote Monitoring Care – https://www.va.gov/GERIATRICS/pages/Remote_Monitoring.asp

Veteran-Directed Care – https://www.va.gov/GERIATRICS/pages/Veteran-Directed_Care.asp

Respite Care – https://www.va.gov/GERIATRICS/pages/Respite_Care.asp

National Hospice and Palliative Care Organization – www.nhpco.org 

Larry Dandridge is a past hospice volunteer, volunteer coordinator, marketing manager, administrator, CEO, and board chairman, and the founder of a hospice in Missouri. An accomplished writer and motivational speaker, he writes columns for the ISLAND NEWS, including the Veterans Benefits Column, What Citizens Should Know About Policing Column, and the Hospice Column. You can contact Larry at his email, LDandridge@earthlink.net. 

EDITOR’S NOTE

These columns are not meant to replace carefully reading local, county, state, and federal law or the need for a lawyer when seeking legal advice. 

Larry Dandridge is not an employee of THE ISLAND NEWS and his opinions are his alone. Readers should rely their Doctor, Physician Assistant, Nurse Practitioner, and Registered Nurse, Medicare, Medicaid, their Private Insurance Company, State Medical Department, the National Hospice and Palliative Care Organization (NHPCO), and the hospice of their choice for advice on hospice. Although every precaution has been taken in the preparation of these articles, the publisher and author assume no responsibility for errors or omissions. Neither is any liability assumed by the author or THE ISLAND NEWS for damages resulting from the use of information contained herein. 





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